Loose Ligaments: The Key to Solving Sports Back Pain

When back pain is due to loose ligaments, a very characteristic behavior of pain is observed. An athlete with loose ligaments of the lumbar spine or pelvis will experience recurring dysfunctions at the intervertebral joint (degenerative disc and possible nerve compression), at the facet joints (locking in flexion or extension), and at the sacroiliac joints. In other words, the low back pain can be due to an unstable disc problem, facet joint locking, or sacroiliac dysfunction.

However, the low back pain can originate in the ligaments themselves. The ligaments in the lower back contain an abundant supply of small nerve endings. Good and strong ligaments will stretch very little when a load is applied to them. When the ligaments are weak, an excessive stretching will occur with the same load. The greater the ligament laxity, the faster the ligament will elongate or stretch. This exaggerated elongation of the weak and overstretched ligaments allows excessive pull on the non-stretchable nerve endings. As a result, pain and/or numbness is felt locally over the ligaments or referred distally in the buttock or in the legs, following a specific pattern for each ligament.

Ligament injury is very painful. This is, in part, because of the nerves in the ligaments, but also because ligament injury typically occurs where the ligament attaches to the bone, an area called the fibro-osseous junction. The outside of the bone, where the ligament attaches (the periosteum), is also full of nerve endings. The most sensitive structures that produce pain according to Daniel Kayfetz, M.D., are the periosteum and the ligaments. It is important to note that in the scale of pain sensitivity (which part of the body hurts more when injured), Dr. Kayfetz explains that the periosteum ranks first, followed by ligaments, tendons, fascia, and finally muscle, respectively. (Kayfetz, D. Occipital-cervical (whiplash) injuries treated by Prolotherapy. Medical Trial Technique Quarterly. 1963; June: 9-29.) When a ligament is injured, pain will be elicited from both the periosteum and the ligament. This is why ligament injury can and does cause severe pain. This also explains why ligament pain can come and go. The ligament will not be overstretched in certain positions, therefore no pain is felt at that time.

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